At the bottom of this blog is a chart that sets out the design of accountability in the LHIN/Health Link health service delivery system model for Collaborative Governance.

In the Collaborative Governance Model, health service providers (HSPs) shift from their silos into a systems approach to governance and accountability.

From the perspective of a health service provider organization, the accountability system includes up to three components:

The Strategic Balanced Scorecard — the four-box framework that sets out the organization’s Board-Approved strategy — including the methodology for tracking progress.

The Service Accountability Agreement With The LHIN — that sets out the organization’s expected outcomes and alignment with the Integrated Health Service Plan which — if best practices were followed — reflects a “fair business bargain” agreed to by the LHIN and HSP. The Service Accountability Agreement will also reflect the Accountability Agreement between the LHIN and the MOHLTC; and, where appropriate,

The Health Link Business Plans contain the newest set of accountabilities that Boards of organizations that have joined a Health Link must add to the other two sets of accountabilities. While the lead partner in the Health Link is accountable to the LHIN, each partner’s board, and their CEO, are accountable for achieving their part of the agreed-upon outcomes.

The chart at the end of this blog also outlines how formal Accountability Agreements between Boards and their CEOs (as well as Chief-of-Staffs in hospitals) reflect the input from those three sources: the internal organizational scorecard; the agreed-upon Health Link outcomes; and, the outcomes required in their Service Accountability Agreement with the LHIN and the local Integrated Health Services Plan.

It shows how the CEO’s Accountability Agreement (and the Chief-of-Staff’s Agreement) drive both the Managerial Accountability Agreements, and the Medical Chiefs’ Agreement in hospitals. Best practices suggests that everyone’s accountabilities — and the “supports they require in order to be successful” — are explicit, fair and balanced.

The Balance Governance Scorecard’s four-boxframework can provide a method to check on the degree of alignment that there is in your system of cascading accountabilities.

The chart below outlines the accountability architecture, from the perspective of a single HSP. From a “system perspective“, we need each of the HSP’s governance boards to hold their CEO’s accountable for each of these three perspectives.

They are no longer just a silo board, they need to think and act like a “system board” on behalf of the whole community.

The key assumption of the Collaborative Governance model is that Boards exist to represent the interests of the “owners” of the organization — not the narrow interests of the organization itself.

So, in addition to holding the CEO accountable for the outcomes in the Board’s approved organizational scorecard, a best practice Collaborative Governance Board would also monitor progress on the LHIN’s service agreement — as well as the appropriate components of the local Integrated Health Services Plan (IHSP); and, the agreed-upon business plan outcomes from their Health Link.

That’s the basic architecture of the Collaborative Governance Model.

For the most part, the people currently talking up the concept of “Collaborative Governance” really only mean that collaboration is a “good thing”. It’s a nice value, rather than an aligned pragmatic accountability system design for governance. In this simple worldview, collaboration is “good” and, as such, ought to be practiced.

But the concept of “Collaborative Governance” must become more than just a “good intention” and a “nice value”, it must be intentionally designed and aligned to actually work to create collaboration at the CEO/Management/and at clinical levels — where integration really counts.

Collaborative Governance needs to be intentionally designed to be an antidote to “silo governance”. It enables silos to be part of the network system. It is intended as a force for integration — if the Boards of Health Links partners would meet together periodically to ask the “wicked” and “probing questions” on behalf of the community: the “owner” of the entire healthcare services delivery system.

When HSPs were just silos, governance boards only held their CEO’s accountable for outcomes in their silo. Today, a major feature of Collaborative Governance is that while Boards exist to ensure good management in their silo, as Health Link Partners, and as members in a common LHIN, they are equally and mutually accountable for improved outcomes in their local healthcare services delivery system as well.

So in the future, Boards would hold their CEO’s accountable for both system-level, and silo-level outcomes. That’s the key leverage point for Collaborative Governance: the integration of system & silo accountabilities. It’s the traction that makes integration actually occur at the Health Link level without setting up yet another “super-board” to govern the whole local system. Nevertheless, Collaborative Governance needs to be much more than just a “good intention”.

The “lead” Health Link partner organization has been entrusted with one million dollars of taxpayers’ funding to support the development of the partners’ agreed-upon action plan. Some of the more strategic CEO-led Health Links (vs. the more operational ones), will be developing Health Link Balanced Scorecards that spell out the “cause-and-effect linkages” between the Customer/Patient/Client outcomes; the Financial outcomes, the Process outcomes, and the Learning & Growth outcomes in their scorecard.

As everyone will discover, when you’ve seen one Health Link, you’ve seen one Health Link. They are a real mix of relationships. Nevertheless, leadership surveys @ TedBall.com demonstrate a very respectable amount of optimism that Health Links will in fact succeed in their mission to transform their local delivery systems.

While concerns have been raised that some Health Links see themselves as a pilot project for the Top 5%, rather than a structure to achieve better integration of services for the whole community — based on the “lessons learned” from the “Top 5% Group”, who consume 66% of all our resources.

For organizational structures to succeed, they need to be designed and aligned to succeed.

However, for whatever reason, Queen’s Park has failed to be very clear about the governance of Health Links, or about how accountability would work. Why? They believe that saying nothing about governance and accountability means they are promoting a “low rules” environment, and that people should feel free to innovate.

So, without a macro-framework for alignment, it will now be up to the 80 individual Health Links to design and align themselves to work as an integrated health services delivery system. Collaborative Governance provides a framework and practices to enable alignment within each Health Link.

The advent of Health Links as formal partnerships — with formal accountabilities — ought to trigger the governance boards of the Health Link Partners to get together — perhaps a couple of times per year — to review the progress being made together by “the partners” in the network.

By bringing the Health Links Partners Governance Boards together to review their local delivery system’s progress; and to explore how the partners could transform the patient experience as they travel across the continuum-of-care; communities, through these boards, could be able to hold “stewardship” for the local health services delivery system’s transformation journey.

As “stewards” for the well-being of their community, our governance Boards need to stretch their minds ahead to 2015 and beyond. They need to understand that there will in fact be significantly fewer resources available for healthcare services immediately after the election. Some organizations could face 10% cuts in their budget, while others will be required to manage rapid growth and expansion.

There will also be a pressing need to re-allocate resources within the existing healthcare delivery system to meet the emerging needs of each unique community. Who is going to do that job?

Governing boards would need to acknowledge that their CEOs manage in toxic, blame-oriented regulatory environments driven by fear and anxiety that starts at Queen’s Park and spreads throughout the healthcare services delivery system. Boards need to explicitly liberate their CEOs to be innovative and creative as healthcare system executives, and as the organization’s strategic and operational leader accountable for silo and system outcomes approved by the Board.

The beliefs and convictions of Ontario’s health sector leadership was captured in the recent health issues survey @ TedBall.com during March Break.

On the question of “Devolution Of Authority” (for allocating resources) to the LHINs, 30% of respondents said they were “very supportive”; another 21% were “supportive”; and a further 25% said they had “some support, with adjustments”. That’s 76% of health system leaders who want devolution. That’s a significant stance that should not be ignored.

Only 13% of respondents were “opposed to the devolution of authority” to the LHINs.

With the arrival of a new Deputy Minister in June, and the expected report of the Legislative Committee studying the original LHIN legislation, there is an opportunity to tag the LHINs with the task of re-allocating fewer resources across their delivery system using provincial standards and their Integrated Health Service Plan as guides.

I very much doubt that the next government really wants to put Queen’s Park in charge of downsizing budgets at the local level — or in charge of re-allocating resources from acute care to community care, based on evidence and population need. That’s the point at which politicians say: shouldn’t the decision about the allocation of resources be a local decision, rather than a centralized bureaucratic decision?

The emerging challenge for Health Link Partner Boards and their CEOs, is: how quickly they can prepare for major transformational change over the next year or more — while funding still remains somewhat stable — as long as we are in “pre-election mode”.

While the next election could actually be as far away as a year from now — and perhaps even to the end of the legislated mandate in 2015, people who have been “putting things off until after the election”, should be asking themselves: why are you waiting? Are you a political candidate, or a healthcare leader?

So, now would also be a good time for Health Link Governance Partners to engage in conversations about Collaborative Governance design — before the financial crunch comes after the election. Smart people, smart communities will be getting their ducks in a row now.

Unfortunately, many LHINs and Health Links may actually wait until their community is in a horrible crisis before moving to action. Some will hold true “stewardship” for their community, and take action much earlier. Today, perhaps 20% to 30% of our healthcare delivery system has actually achieved a state of “readiness for transformation”.

There are a number of LHINs that are currently already engaging their HSP governance boards about governance, and about the concept of Collaborative Governance. But given that 70% of all major large-scale change efforts fail, it is very possible that only 30% of our Health Links will actually succeed in the end. That may be the case in some LHINs.

There are mixed reports on the behaviors and operating assumptions of our 14 LHINs. Respondents to our recent March Break Health Leaders’ Survey had a distinct pattern.

40% said they had “little” to “no confidence” that LHINs would contribute to the success of the Health Link Program. That is a significant level of negative judgment about our existing LHINs, and their capacity to support transformation.

32% of Ontario healthcare leaders said they have “some confidence” that LHINs will help the Health Links initiative to succeed. 28% said they had “high” to “great” confidence that these local integrated health systems would succeed. That’s 60% who have some degree of confidence that LHINs would help the Health Links succeed. Form a change management perspective, that’s a solid critical mass going forward.

But if Health Links are to become the “transformational” vehicle that Queen’s Park claim they are, the partner CEOs and senior managers need to be liberated by the governors to develop the strategy and a plan for aligning the structures, culture and skills of the partnering organizations to create a better more seamless experience for patients.

If every Board told their CEO that among their highest priority is the creation of a “seamless experience” as patients and their families move across the continuum-of-care in their community, we would achieve the integrated system taxpayers are demanding. The foes of local governance say that these silo-boards are in fact urging their CEOs to build a self-serving empire at each organization.

That could be true in 10% to 15% of “old-school cheerleader boards”.

Today, in addition to each Board holding their CEO’s accountable for system and Health Link outcomes, Collaborative Governance design could also include an aligned structure for regular quarterly meetings of Health Link Board Chairs/Vice Chairs in order to review the overall Health Link Scorecard, and to engage in generative dialogues on high-level strategic directions for the Health Links Partnership.

Notice I’m not advocating for a new layer of Health Link System Governance. Collaborative Governance is about the self-organizing capabilities of systems. It is not about new structures. It’s about new conversations, and new behaviors.

Of the three governance modes of Strategic/Fiduciary and Generative, the Collaborative Governance Partners’ Council needs to focus primarily on being “generative“.

On behalf of the “owners” of our healthcare delivery system, they should invest perhaps four days per year asking “wicked” and “probing” questions that will help management uncover the strategic directions required to achieve the vision for a more integrated delivery system, that improves the patient experience, and achieves the goal of improved health status of the population served.

Health Links need to become learning communities, and the governance boards need to play a role in facilitating learning, in their organizations, and across the sector.

The challenge: Queen’s Park seems to be totally perplexed by governance and best practice governance concepts — including their own incredible track record of actually implementing “worst practice” governance models at the Family Health Team level. In addition, a number of key people in the Queen’s Park inner-circle of policy influencers are “anti-governance”. This is the “Fewer Boards are Better” camp.

The “fewer boards are better” advocates apparently do not accept the research from Canadian Patient Safety Institute (CPSI), and from Institute For Health Improvement (IHI), that suggest that properly trained governance boards can actually add significant value towards improving health quality, patient safety and the patient experience.

The anti-governance advocates don’t acknowledge these points. They simply say that silo-governance causes system fragmentation. They say the solution is to just “get rid of them”.

As always, there is some degree of truth in the anti-governance group’s charges. Some governance boards — particularly our Health Science Centre Boards, and sometimes boards of smaller hospitals — do push their CEOs to be silo-centric, rather than system-centric.

All the Minister of Health, (or even the LHINs) need to do is “call them out on it”, when Boards are being silo-centric.

So far, this anti-governance sentiment has only manifested itself as neglect from Queen’s Park. The problem is, if Health Links fail because there was not a best practices approach to governance and accountability, who will be accountable? Would that be the Minister’s, or the MOHLTC’s responsibility to ensure that the program they designed actually works?

The answer is: it’s both.

While these are still early days, we are now entering into our second year with the Health Links program. What are we learning? What’s working? What’s not?

The best current examples of emerging Collaborative Governance in Ontario is at the North Simcoe Muskoka LHIN — led by Board Chair, Bob Morton; and at the SELHIN,led by Board Chair, Donna Segal. People should access their slide deck presentations from their upcoming April 28th OHA Workshop presentations to understand their respective approaches to Collaborative Governance.

While these slide-decks outline the logic of the approaches being taken by the NSM LHIN and by SE LHIN, the glue that actually holds their process together is trust, ownership and commitment. Trust enables true collaboration, and, with practice, synergy.

In the Collaborative Governance Model, if Board Chairs, Vice-Chairs and Committee Chairs of Health Link partner boards were to meet three or four times per year as the HSP governors, they could monitor the systems’ evolving progress, and explore potential leveraged actions that would propel the whole system forward — the wonderful world of continuous improvement and strategic learning.

We have yet to get accountability design right in our healthcare system.

So, in this “low rules” environment — where government has no clear views on governance and accountability for Health Links — health system leaders should take some time to think about it: how could your organization better integrate the multiple outcomes for your organization — and for the larger system at the LHIN and Health Link levels?

Quantum Mission

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What Patients Want

We can help with

Patient Experience Design Methodologies

Read about Experience Design Storyboard And Master Process. These truly innovative and effective methodologies are very exciting because they transform the customer/patient /client experience – while significantly improving efficiency and creating more satisfied and engaged healthcare service providers.

Drug Savings

Read a great paper by the extraordinary public servant, Helen Stevenson, who saved $1.5 billion in ODB costs.

Getting To Integration: Command & Control/Emergent Process

Are mergers of small organizations really going to improve our healthcare system? Read this paper in the Public Sector Innovation Journal by Steve Lurie, CMHA, Toronto.

World-Class Resource

"Ted is a world-class resource for providing insight and intelligence to understanding and solving complex challenges. He regularly can recall a myriad relevant ideas and experiences that can be either practical or thought-provoking. If there was something important but impossible to do he is the first one I'd call."-- Art Frohwerk, Managing Partner at Clearpath, LLC

Honestly & Integrity

"Ted Ball is a brilliant system thinker, and the best intelligence gathering resource Ontario has. But, what is uniquely exquisite about Ted, is his no non-sense attitude, honesty and integrity to share information generously and widely. Working with Ted is at once - inspiring, stimulating and fun! "

Second curve leaders

Download Designing and Creating Second Curve Healthcare System to discover more about our evolving health system. As you read through what the system will be like over the next three to five years, what do you think are the skills and capabilities required by 2nd Curve Leaders.

Conference Speaker/Retreat Facilitator

Ted Ball is available to address conferences or design retreats for Governance & Management. Give him a call @ 416-581-8814 and explore your unique circumstances.

Warning

Seventy percent of all major change projects fail. While 30% succeed, Quantum’s curriculum reflects the “lessons learned” from the 15% who experience dramatic performance improvements.

This Stuff Works!

“After our two-year investment in capacity-building with Quantum, we had remarkable performance improvements and extraordinary value. Today, our 120 directors, managers and other key leaders are not just more strategic, more aligned and more leveraged, they are also happier, more collegial and more effective as leaders and managers. We are achieving real results with these adult learning technologies and systems thinking tools.”

Bonnie Adamson
Former CEO, North York General Hospital, 2008

Leadership Development

TED BALL has been a coach, guide and mentor to CEOs, Ministers of Health and Executive Directors of community agencies for 20 years. Now, through the Quantum Leadership Institute, you can access Ted’s leadership coaching insights as well as the powerful learning tools from Quantum to prepare you as a 2nd Curve health system leader. Following an assessment and evaluation dialogue with Ted Ball, coachees can either co-design a leadership learning journey to match their unique needs and budget, or determine that other types of investments in their learning & growth would be more appropriate for their goals.

Releasing Human Capacity

“I was so inspired by the coaching model Ted used, I decided to work on a PhD and learn more about human potential and how to release it.”

The Patient Voice Poised To Become The Dominant Driver

Today’s healthcare providers were not trained to provide PCC. They lack the requisite skills, and patient empowerment unsettles them.

The term PCC does not accurately describe what modern patients seek. Patients do not want to be at “the centre” of a healthcare construct; they want to be recognized as full partners in their care, and are speaking about this with an increasingly unified and powerful voice.

Indeed, while economics, demographs, and technological advances will continue to prompt change ‘the patient voice’ is poised to become its dominant driver.”

Learn how to deal more effectively with the Provincial Government. Darwin Kealey & Leonard Domino have advise here: Leonard Domino

We can help with

Measuring What Matters

“There is a clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded. Canadian values have shifted substantially in recent years, towards a preference for greater autonomy and empowerment in managing their health care and management. Canadians' values reflect the desire for a more ‘personalized’ health care system, one that engages every individual patient in a collaborative partnership with health providers, to make decisions that support health, wellness, and quality of life.”
Click here for the executive summary of Measuring What Matters: The Cost vs. Values of Health Care – a must read white paper from the Ivey Centre for Health Innovation.

Heart In Healthcare

Become part of the worldwide movement to re-humanize healthcare. Heart In Healthcare aims to:

• To encourage health workers to reconnect to the heart of their practice
• Allow compassionate caring to rise above institutional rules and limitations
• Create the world’s most inspiring community of health professionals, students, patient advocates and leaders, working together in a worldwide movement to transform healthcare from within.

Big Changes Ahead For Health “System”

Changing Structures Too Expensive/Disruptive

"In Ontario unless there is a compelling political and financial case made to restructure the system, it’s safe to assume that Ontario will not move to formalize health system integration through disbanding organizations and creating regional health authorities. The evidence is overwhelming that not only would it be an extremely expensive proposition – somewhere in the $4-5 billion range to harmonize wages – but it would also be extremely disruptive – taking some 4-5 years to re-establish some form of equilibrium – and could also have a significant negative impact on foundation fundraising on which hospitals in particular are dependent."

Saskatchewan Health Plan Five-Year Outcomes

• There will be a 50% improvement in the number of people surveyed who say, “I can contact my primary healthcare team on my day of choice”.
• There will be a 50% reduction in the age-standardized hospitalization rate for ambulatory care sensitive conditions.
• (by March 31, 2014) All patients have the option to receive necessary surgery within three months.
• Zero surgical infections from clean surgeries.
• No adverse events related to medication errors.
• The healthcare budget increase is less than the increase to provincial revenue growth.
• The healthcare budget is strategically invested in information technology, equipment and facility renewal.
• Zero work place injuries.
• (by March 31, 2022) there will be a 5% decrease in the rate of obese children and youth.
• There will be a 50% reduction in the incidence of communicable disease.
• Seniors will have access to supports that will allow them to age within their own home and progress into other care options as their needs change.
• Patients’ ratings of exceptional overall healthcare experience are in the top 20% of scores internationally.
• There will be a 50% reduction in patient waits from General Practitioner referral to specialist and diagnostic services.
• (by March 31, 2015) all cancer surgeries or treatments are done within the consensus-based timeframes from the time of suspicion or diagnosis of cancer.
• Individuals with severe complex mental health issues with alcohol co-morbidity or acquired brain injury will have access to supportive housing in or near their community.
• No patient will wait for emergency room care (patients seeking non-emergency care will have access to more appropriate care settings).
• Employee engagement provincial average score exceeds 80%.
• Increase physician engagement score by 50%.

Hospital leadership

“Over time, we'll need fewer and fewer hospitals. Boards of those institutions need to just remember that the scope of what they need to do is to be responsible for the health of people, not the preservation of the institutions."

—Clayton ChristiansenDisruptive Innovation

Leadership

“The most important lever for change is modeling the change process for other individuals. This requires that the people at the top engage in the deep change process themselves.”-- Robert E. Quinn
Deep Change

Real Devolution

“A regional health authority, if it’s going to be effective, should be able to determine how money is spent within a region, shifting money from hospitals to community care, from treatment programs to prevention, and so on. This approach worked extremely well in Alberta, so well that it was dismantled because it stripped too much power and control from politicians and policy-makers in the Health Ministry.”-- André Picard
The Globe and Mail

Warning

Seventy percent of all major change projects fail. While 30% succeed, Quantum’s curriculum reflects the “lessons learned” from the 15% who experience dramatic performance improvements.

The Patient-Centred Care Experience:

Like rainbows, examples of patient-centered care are few and far between, but here are some tell-tale signs:
• Providers and patients know each others’ names;
• Patients’ opinions are actively sought, listened to and honored where possible;
• Patients tell you that their doctors and other team members really listened to what they had to say;
• Patients are treated as the most important member of their health care team and taught how they can best contribute to the team’s success;
• Providers feel that their patients are actively involved in their own care; and,
• You see a significant improvement in patient health status, adherence, engagement, level of utilization and patient/provider experience.
-- Steve WilkinsMind the Gap

What is Patient-Centred Care?

Patient-centered care means involving patients in the planning, delivery and evaluation of health care where it really counts in terms of outcomes, patient adherence, cost reduction and fewer re-hospitalizations.
Being patient-centered is like doing a market research study and then implementing the findings. Patient-centered care does not give absolute control to patients, it simply invites them into the party and gives them a place at the table. As providers, we don’t do a good job of listening to patients. We do an even worse job when it comes to acting on what patients tell us they want.
-- Steve WilkinsMind the Gap

Guiding Principles For Patient-Centred Care

1. Care is based on continuous healing relationships.
2. Care is customized and reflects patient needs, values and choices.
3. Families and friends of the patient are considered an essential part of the care team.
4. Knowledge and information are freely shared between and among patients, care partners, physicians and other caregivers.
5. Patient safety is a visible priority.
6. The patient is the source of control for his or her care.
7. All team members are considered caregivers.
8. Care is provided in a healing environment of comfort, peace and support.
9. Transparency is the rule in the care of the patient.
10. All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. (Borrowed from Margaret Gerteis et al.(Through the Patient’s Eyes)

Canada on Top:

Canada was in the top spot for the number of accidental punctures or lacerations during surgery out of the 17 countries surveyed by the Organization for Economic Co-operation & Development (OECD).

At 525 per 100,000 hospitalizations, its rate was more than three times as high as Britain (174) and the U.S. (166).

Patient Engagement:

“Almost half of Canadians with a regular doctor feel engaged in their healthcare. By engaged, we mean that patients always have enough time during visits, can always ask questions about recommended treatment, and are as involved as they want to be in decisions about their care.”

– Health Council of Canada Bulletin 5
September, 2011

Learning Organization

According to David Carnevale, author of Trustworthy Government, one of the key differences between learning organizations and traditional controlling organizations “is that deeply ingrained defensiveness so characteristic of low-trust, traditional bureaucratic organizations undermines necessary learning. Trust expedites learning.”
Carnevale says that “Healthy learning organizations are managed with the objective of liberating and using employee know-how to improve work processes. The emancipation of employee know-how is enabled through a different philosophy of organization and job design, communication patterns, labor-management relations, participatory methods, and other processes that reduce the climate of fear and allow staff the necessary psychological peace of mind to fully engage their work”.

Assumption of Competence

Traditional bureaucratic organizations are dominated by the need for control and conformity -- assuming that workers are incompetent, and therefore must be carefully managed. In turn, this creates high degrees of mistrust, defensiveness and fear -- all of which undermine learning.

In learning organizations, the assumption of competence is supported through the encouragement of curiosity, creativity and innovation. The people who deliver the organization’s services directly to its customers are encouraged to use their know-how to improve work processes. While successes are a cause for celebration, learning organizations must also accept and forgive mistakes as part of the learning process. They must be open to learning from their “best mistakes”.

Leadership/Adaptive

Adaptive leadership means raising tough questions rather than providing answers; it means framing the issues in a way that encourages people to think differently, rather than laying out a map of the future; it means co-creating with people their new roles, power relationships, and behaviors, rather than orienting them in a new direction and giving them a big push.

Shared Vision

At its simplest level, a shared vision is the answer to the question: “What do we want to create. A shared vision is the vision that people throughout an organization or a community of organizations carry about what we want to be in the future.
Peter Senge describes the concept of a Shared Vision in his book The Fifth Discipline. He writes, “a shared vision is not an idea. It is, rather, a force in people’s hearts, a force of impressive power. It may be inspired by an idea but once it goes further - if it is compelling enough to acquire the support of more than one person - then it is no longer an abstraction. It is palpable. People begin to see it as if it exists. Few, if any, forces in human affairs are as powerful as a shared vision.”

Shifting Gears Report:

“Devolve decision-making selectively and where appropriate. Policy makers should consider expanding the accountability functions of regional bodies, strengthening specialty care networks, and supporting organic mergers and acquisitions within the system. Any system transformation primarily focused on significant governance reforms—for example by reinventing regional bodies from scratch—could actually distract attention from the more organic reforms needed that will have a positive impact on fiscal sustainability and produce unnecessary delay in implementing transformative change.”
– University of Toronto

Health Care & Physicians Costs

“A healthy economy and shrinking government debt over the past decade seem to have been the main drivers for soaring health-care spending, while the much-feared aging of the population is having relatively little impact on medicare's bottom line, a new federal-provincial report concludes.
CIHI said that total health spending - by governments as well as private individuals and health plans - is set to reach $200-billion this year, about $5,800 per person. That is an increase of 4%, the smallest one in 15 years.
A separate report looked at the drivers of health spending between 1998 and 2008, when the figure rose by an average of 7.4% per year.
Spending on physicians is the fastest-growing chunk of the budget now, with the increase for 2011 projected to slow slightly to 5.6%. More doctors are being added to the system - 6,500 between 2005 and 2009 - while their income rose by an average of 3.6% per year. That followed a period from 1975 to 1998, however, when MD compensation rose more slowly than other public goods and services.”